Facial Skin Cancer Surgery

Skin cancers commonly affect the face because it is one of the most sun-exposed parts of the body, and Australia has high rates of skin cancer. The face also presents particular challenges because removing and reconstructing a skin cancer here is different from doing so on the body. The face has important cosmetically sensitive structures close together, such as the eyelids, nose and lips, and both function and appearance need to be considered when planning treatment.

For these reasons, Dr Ricketts recommends that a specialist surgeon perform skin cancer surgery on the face. The goals are to remove the cancer completely and to reconstruct the area so that it heals well and the affected structures continue to work and look as they should. Her reconstructive experience, including public hospital work in major facial reconstruction, informs her approach to these cases.

This page provides general information about facial skin cancer surgery. Skin cancer is a medical condition, and the right treatment depends on the type of cancer, its size and its location, which is assessed individually. The most common skin cancers affecting the face include basal cell carcinoma and squamous cell carcinoma, and less commonly melanoma, each of which is managed according to its own characteristics.

In some circumstances curettage, deep shave or topical treatments may be appropriate (creams). However surgical treatment involves removing the skin cancer with a margin of surrounding tissue to give the best chance of clearing it completely, then reconstructing the resulting defect. Reconstruction may be a direct closure, a skin graft, or a local flap, where nearby tissue is moved to fill the area, depending on the size and site of the defect. On the face, the choice of reconstruction is guided by the need to protect structures such as the eyelid, nose and lip and to place scars where they settle as discreetly as possible. In some cases the pathology results guide whether further removal is needed before the reconstruction is finalised.

At your consultation, Dr Ricketts examines the lesion and the surrounding area, reviews any biopsy or imaging results you have, and discusses the type of cancer and the treatment options. She explains how the cancer would be removed, how the area would be reconstructed, the likely scars, the recovery and the risks. She will also talk with you about ongoing skin checks, because people who have had one skin cancer are at a higher risk of developing others. Please bring any referrals, biopsy reports or pathology results to your appointment.

Some facial skin cancer procedures are done under local anaesthetic as an office procedure. Others are performed as a day case under local anaesthetic and sedation or general anaesthetic depending on the location and complexity of the surgery. If a larger reconstruction is needed, general anaesthetic and occasionally an overnight stay may be required. On the day, Dr Ricketts will go over the plan with you and mark up your lesion and reconstruction prior to you entering the operating room. The team will be there throughout the procedure and your recovery. Before you leave, you will be given wound care instructions, along with a follow-up appointment to tend to your dressings and suture removal and to go through your pathology results.

How long recovery takes depends on where the cancer was, how large it was, and what type of reconstruction was done. In the first week or two, some swelling and bruising is normal, and you’ll have a dressing over the wound. Stitches on the face are typically removed after about one week. If you’ve had a larger reconstruction or skin graft, wound care is more involved and settling can take longer.

Over the months that follow, the scar will gradually soften and fade. Keeping it out of the sun during this time helps it settle as well as possible. Dr Ricketts will give you tailored wound care and follow-up instructions, including advice about ongoing skin checks, and will go through your pathology results with you. If further treatment is needed, she’ll discuss this at your follow-up. Healing is individual, and results vary from person to person.

Dr Sophie Ricketts is a specialist plastic surgeon based in Richmond, Melbourne, with a focused practice in facial surgery, including skin cancer surgery. She is a Fellow of the Australian and New Zealand College of Surgeons (FRACS) and a member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the peak professional bodies for plastic surgery in Australia. You can also find her on RealSelf. Each of these listings is maintained by independent organisations and provides patients with a straightforward way to check the qualifications, training, and scope of practice of the listed providers before booking a consultation.